OHCA to increase provider reimbursement rates for first time since 2009

Posted on: 9/5/18

In collaboration with state and legislative leadership, the Oklahoma Health Care Authority (OHCA) will give the first across-the-board reimbursement rate increases since 2009 to long-term care and other SoonerCare (Oklahoma Medicaid) providers. No new state dollars, carryover or other one-time funds will be used for the increases, which are planned to go into effect on Oct. 1. 

The agency is moving forward with the required public notification process and will present the proposed increases for action at upcoming public meetings, including the Sept. 10 State Plan Amendment Rate Committee and the Sept. 13 OHCA board meeting.

Consistent with the legislative direction of Senate Bill 1605 that was signed into law in May 2018, OHCA will propose using program and administrative savings and record drug rebate collections to increase the provider rates by four percent for long-term care facilities and three percent for other certain contracted provider types or groups.

As also directed in the legislation, these rate increases will be in compliance with federal and state law and regulations, as well as state cost reimbursement methodologies. 

“Increasing provider reimbursement rates has long been a priority to the Legislature and me,” said Gov. Mary Fallin. “I commend the Oklahoma Health Care Authority for overcoming historical budgetary constraints and achieving this goal by efficiently managing precious agency resources. Restoring rates is a positive measure to foster continued partnership with providers, which benefits not only members, but our state as a whole.”

“The OHCA shares a common intent with state and legislative leadership to increase provider rates. We recognize the importance of rates to sustaining our provider network and ensuring access for our members,” said OHCA CEO Becky Pasternik-Ikard. “State fiscal year 2018 reflects a multitude of efforts and hard work by leadership and the Health Care Authority. We appreciate being in the position to increase rates and are thankful our providers stayed with us through difficult budget years.”  

A three percent rate increase will put SoonerCare physician rates at about 89.17 percent of the Medicare physician fee schedule. In addition to physician rates, the three percent increase will affect most provider types including hospitals and pharmacies.

The meetings will be held at the OHCA in the Charles (Ed) McFall Boardroom, 4345 N. Lincoln Blvd., Oklahoma City. Anyone interested is encouraged to attend.   

Additional information about these meetings, including agendas, will be posted at www.okhca.org/calendar as the information becomes available.